Provider Demographics
NPI:1194899096
Name:TOMAQUIN, MEDARDO
Entity type:Individual
Prefix:MR
First Name:MEDARDO
Middle Name:
Last Name:TOMAQUIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7090
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0708
Mailing Address - Country:US
Mailing Address - Phone:707-287-8545
Mailing Address - Fax:707-253-7269
Practice Address - Street 1:2100 NAPA VALLEJO HWY
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6234
Practice Address - Country:US
Practice Address - Phone:707-253-1009
Practice Address - Fax:707-253-7269
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health